PREDIABETES Strategies for Effective Screening, Intervention and Follow-up

PREDIABETES

PREDIABETES

Strategies for Effective Screening, Intervention and Follow-up

Learning Objectives

● Define prediabetes● List risk factors and clinical signs in

individuals at risk for type 2 diabetes● Identify interventions to modify risk factors

to preventing type 2 diabetes● Develop a strategic management plan to

proactively screen, assess, follow-up, and evaluate patients with prediabetes

● Discuss the benefits of a team-based approach to assist individuals with prediabetes to achieve their target goals and objectives

Adapted from: American Diabetes Association. Diabetes Care. 2014;37 Suppl 1:S81-90.

Normal

Diabetes Mellitus

PrediabetesImpaired Glucose

Tolerance

Fasting PlasmaGlucose

Fasting PlasmaGlucose

126 mg/dL 126 mg/dL

2-hour Plasma Glucose On

OGTT

2-hour Plasma Glucose On

OGTT

200 mg/dL 200 mg/dL

140 mg/dL 140 mg/dL

Any abnormality must be repeated and confirmed on a separate day Any abnormality must be repeated and confirmed on a separate day

The diagnosis of diabetes can also be made based on unequivocal symptoms and a random glucose >200 mg/dLThe diagnosis of diabetes can also be made based on unequivocal symptoms and a random glucose >200 mg/dL

100 mg/dL 100 mg/dL

PrediabetesImpaired Fasting

Glucose

What is Prediabetes?

Normal

Diabetes Mellitus

Hemoglobin A1CHemoglobin A1C

6.5% 6.5%

5.7% 5.7%

Prediabetes

Normal

Diabetes Mellitus

Prediabetes

● An important risk factor for future diabetes and CV disease

● Risk for prediabetes is a continuum● Important to identify early and begin

intervention immediately● Interventions can reduce the rate of

progression from prediabetes to diabetes

o Healthy dieto Physical activityo Weight loss

American Diabetes Association. Diabetes Care. 2014:37 Suppl 1:S81-90.

Prediabetes

● Long-term consequences includeo Hypertension1

o Cancer2

‒ Risk increased by 15%‒ Stomach/colorectal, liver, pancreas,

breast, endometrium o Alzheimer’s disease3

1. American Diabetes Association. Diabetes Care. 2014:37 Suppl 1:S81-90.2. Baker LD, et al. Arch Neurol. 2011;68:51-57.3. Huang Y, et al. Diabetologia. 2014 Sep 11. [Epub ahead of print]

Impaired Fasting Glucose and Impaired Glucose Tolerance

● Not clinical entities but rather risk factors for diabetes and cardiovascular disease

● Associated with:o Physical inactivityo Obesity (especially abdominal, or visceral)o Dyslipidemia

‒ High triglycerides and/or low HDL cholesterol

o Hypertension

American Diabetes Association. Diabetes Care. 2014:37 Suppl 1:S81-90.

PrediabetesCenters for Disease Control, 2012

● 37% (86 million) U.S. adults aged 20 years or older have prediabetes1

o Percentage was similar by race

o 51% aged ≥65 years

● Only 11% were aware they had it2

● In adolescents aged 12 to 19 years, prevalence of prediabetes and diabetes increased from 9% to 23%3

1. National Diabetes Statistics Report. Available at: cdc.gov/diabetes/pubs/statsreport14.htm. 2. CDC. MMWR Morb Mortal Wkly Rep. 2013;62:209-212.3. May AL, et al. Pediatrics. 2012;129:1035–1041.

Adapted from:Boyle JP, et al. Popul Health Metr. 2010;8:1-12.

Projecting the Future Diabetes Population:It Is Growing

Determinants of Prediabetes/Type 2 Diabetes: A Call to Action

Adapted from:Hill J. O. et al. Diabetes Care. 2013;36:2430-2439.

● There is an association between social and environmental factors and development of obesity and type 2 diabetes

● Better understanding neededo Variables that influence behaviors that

lead to obesity, prediabetes, and diabetes

o How to modify these variables● Perform research conducted on community-

level interventions● Identify individuals at risk

PrediabetesProcess for Diagnosing

S Screen

A Assess and Advise

F Follow-up

E Evaluate progress

S Screen

A Assess and Advise

F Follow-up

E Evaluate progress

Screening for Diabetes

● Be proactive in an effort to improve outcomes● Find who might have risk factors● Ask patients to take the ADA

Diabetes Risk Test*● Depending on results, invite

them into the office to be tested ● If diagnosed with diabetes/

prediabeteso Assess and adviseo Follow-upo Evaluate

* Available at: www.diabetes.org/risktest

Criteria for Screening for Prediabetes/Type 2 Diabetes in Asymptomatic Adult Individuals

● Consider testing (screening) all adults with a BMI* ≥25 kg/m2 and additional risk factorso If no risk factors, consider

screening no later than age 45 years

● If normal results, repeat testing (screening) at ≥3-year intervalso More frequently depending

on initial test results and risk factors

o Test yearly if prediabetes

DIABETES RISK FACTORS●Physical inactivity

●First-degree relative with diabetes

●High-risk race/ethnicity

●Women who delivered a baby weighing >9 lb or were diagnosed with GDM

●Hypertension (≥140/90 mmHg or on therapy for hypertension)

●HDL-C <35 mg/dL and/or a TG >250 mg/dL

●A1C ≥5.7%, IGT, or IFG on previous testing

●Other clinical conditions associated with insulin resistance, such as severe obesity, acanthosis nigricans, PCOS

●History of CVD

Adapted from: American Diabetes Association. Testing for Diabetes in Asymptomatic Patients.

Diabetes Care. 2014;37(suppl 1):S17; Table 4

*At-risk BMI may be lower in some ethnic groups

Modifiable Risk Factors of Diabetes/Prediabetes for CV Disease

American Diabetes Association. Diabetes Care. 2014:37:S14-80.

Non-modifiable

Age

Race/Ethnicity

Gender

Family history

Modifiable

Physical inactivity

Overweight/Obesity

Hypertension

Smoking

Abnormal lipid metabolism

High plasma glucose levels

CHILDREN/ADOLESCENTS

S Screen

A Assess and Advise

F Follow-up

E Evaluate progress

Prevalence of Prediabetes inChildren/Adolescents in the U.S.

Li C, et al. Diabetes Care. 2009;32:342-347.

Screening Children for Prediabetes and Diabetes

Consider for all children who are overweight and have 2 of any of the following risk factors

● Family history of type 2 diabetes in first- or second-degree relative● High-risk race/ethnicity● Signs of insulin resistance or conditions associated with insulin

resistance● Maternal history of diabetes of GDM during child’s gestation

Begin screening at age 10 years or onset of puberty

Screen every 3 years

A1C test is recommended for diagnosis in children

Adapted from:ADA. Testing for Diabetes in Asymptomatic Patients.

Diabetes Care. 2014;37(suppl 1):S17-18.

GESTATIONAL DIABETES (GDM)

S Screen

A Assess and Advise

F Follow-up

E Evaluate progress

GDMProgression to Prediabetes

● With GDM, the risks for abnormal glycemia can persist even after the early postpartum period

3%

17%

0

4

8

12

16

20

NGT During & 3 months Postpartum

GDM during butNGT 3 months Postpartum

Perc

en

t (%

)

n=73 n=70

Adapted from:Retnakaran R, et al. Obesity (Silver Spring). 2010;18:1323-1329.

Risk factors included:

• 3-month postpartum glucose

• Leptin

• HDL-C

• LDL-C

• Triglycerides

• Adiponectin

Risk of Prediabetes in Adolescent Offspring of Mothers with GDM

Adapted from:Holder T, et al. Diabetologia. 2014; DOI 10.1007/s00125-014-3345-2.

Obese adolescents with normal glucose tolerant (NGT) (N=255)

No Exposure to GDM(n=210; 82.3%)

Exposure to GDM(n=45; 17.7%)

91.4%

8.6%

68.9%

31.1%

0

20

40

60

80

100

NGT IGT/T2DM NGT IGT/T2DM

Perc

enta

ge (

%)

Approx 5.75 times increase in risk; p < .001

GDMScreening and Diagnosis

ONE-STEP (IADPSG)

Screening (at 24-28 weeks gestation)

●75-g OGTT in the AM after an overnight fast of at least 8 hours; measure PG during fasting, at 1 hour, and at 2 hours

Diagnosis

●Any of the following PG values are exceeded

oFasting: ≥92 mg/dL (5.1 mmol/L)

o1 hr: ≥180 mg/dL (10.0 mmol/L)

o2 hr: ≥153 mg/dL (8.5 mmol/L)

TWO-STEP (NIH Consensus)

Screening (at 24-28 weeks gestation)

●50-gram non-fasting OGTT with PG measurement at 1 hour (Step 1)

●If PG level at 1 hour after load is ≥140 mg/dL* (7.8 mmol/L), proceed to 100-gram fasting OGTT (Step 2)

Diagnosis

●3-hour post-test PG is ≥140 mg/dL*

(7.8 mmol/L)

For women not previously diagnosed with overt diabetes: Use 1 of 2 methods

Adapted from:American Diabetes Association. III. Detection and Diagnosis of GDM.

Diabetes Care. 2014;37(suppl 1):S19; Table 6.

*ACOG recommends 135 mg/dL in high-risk ethnic minorities with higher prevalence of GDM

ECONOMIC IMPACT OF PREDIABETES

S Screen

A Assess and Advise

F Follow-up

E Evaluate progress

The Cost of Prediabetes● National annual medical costs of prediabetes

exceeded $25 billion; an excess of $443 per person (average)

Adapted from:Zhang Y, et al. Popul Health Manag. 2009;12:157–163.

Per Capita Ambulatory Medical Costs, Adult Population, 2007

Cost Component US AverageExcess Associated with Prediabetes

By Service Type $1,296 $443

Outpatient visit $215 $67

Physician office visit $553 $183

Medications $528 $194

By Complication Group $1,296 $443

Neurological symptoms $16 $5

Cardiovascular disease $49 $5

Hypertension $74 $57

Endocrine/metabolic complications $16 $11

All other medical conditions $1,017 $355

Impact of Concomitant Hypertension on Healthcare Costs* in Persons with Diabetes

Adapted from:Francis BH, et al. Curr Med Res Opin. 2011;27:809-819.

* Compared to those without diabetes

Herman WH, et al for the Diabetes Prevention Program Research Group.Ann Intern Med. 2005:142:323-332.

● Lifestyle cost-effective, metformin marginally cost-saving vs placebo

● Investment in lifestyle, metformin interventions for diabetes prevention in high-risk adults provides good value

Diabetes Prevention Program10-Year Cost-Effectiveness

Societal Perspective

Lifestyle vs Placebo

Metformin vs Placebo

Lifestyle vs Metformin

DPP Group Lifestyle vs

Placebo

Undiscounted 11,274Cost-

saving44,562

Cost-saving

Discounted 14,365Cost-

saving42,753 1,681

Diabetes Prevention Program Research Group. Diabetes Care. 2012;35:723-730.

Impact of ILI on Cost of Healthcare: Look AHEAD

Adapted from:Espeland MA, et al. Diabetes Care. 2014;37:2548-2556.

Overall 10-year difference: $5,280 ($3,385, $7,175)Annual cost per individual: $8,321(ILI) vs. $8,916 (DSE); p = 0.002

DSE: $78,361

ILI: $73,081

DSE=diabetes support and education; ILI=intensive lifestyle intervention

S Screen

A Assess and Advise

F Follow-up

E Evaluate progress

Assessing Patients With Prediabetes

● What does the patient already knowo Determine what a patient already understands —

or misunderstands — at the start of discussions● What does the patient want to know

o Assess whether the patient desires, or will be able to comprehend, additional information

● What is of concern/importance to the patiento e.g., for women contemplating pregnancy,

uncontrolled glucose levels have been associated with birth defects

● Tailor information desired level of informationo Improves comprehensiono Limits emotional distress

Adapted from: Travaline JM, et al. J Am Osteopath Assoc. 2005;105:13-18.

Assessing Patients With Prediabetes (Con’t)

● Evaluate the spectrum of predisposing risk factorso Existence of one may mean others might also exist

● Talk with the patient about their disease ● Involve them in developing a management strategy,

especially changes in lifestyle‒ Weight loss‒ Increase activity‒ Healthy eating

● Refer too Other members of the healthcare teamo Tools and other sources of educational information

MANAGEMENT STRATEGIES

S Screen

A Assess and Advise

F Follow-up

E Evaluate progress

Steps for Achieving Treatment Goals

● Assess

● Generate goals

● Record

● Evaluate

● Empower

American Diabetes Association. 2008.

Re-assess

● Focus on developing specific objectives

● Let the patient take the lead

● Keep goals/objectives “FIRM”

o Few in number

o Individualized

o Realistic

o Measurable (frequency and duration)

Steps for Achieving Treatment Goals (Con’t)

Saunders JT, Pastors JG. Curr Diabetes Rep. 2008;8;353-360.

Risk Stratification1 and Management Strategies for Prediabetes

Risks and treatments Low Medium High

Hemoglobin A1C, % 5.7–5.8 5.9–6.1 6.2–6.49

Risk stratification √ √ √

A1C target: <5.7% √ √ √

Lifestyle modification, 16-week course √ √ √

Lose 7% of body weight if BMI ≥25 kg/m2 √ √ √

Physical activity ≥150 minutes/week √ √ √

Pharmacologic therapy (e.g., metformin)* √

Gastric bypass surgery† √

Adapted from:1. Tuso P. Perm J. 2014 Summer;18:88–93.

* Consider in low and medium risk if no weight loss after 16-week lifestyle modification course

† BMI ≥40 kg/m2 with no risk factors or ≥35 kg/m2 1 or more severe obesity-related co-morbidities and/or if no weight loss after lifestyle modification and/or metformin therapy

Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The

Evidence Report. NIH Publication # 98-4083, September 1998, National Institutes of Health. American Diabetes Association. Diabetes Care. 2014;37(suppl 1):S14-S80.

Lifestyle ModificationFacilitating Weight Loss

● Initial target: 1-2 pound/week weight loss

●Long-range goal: 7% loss of body weight

● Increase physical activity to ≥150 min/week

● Individualized medical nutrition therapy

●Provided by a registered dietitian

NIH Publication # 98-4083, September 1998, National Institutes of Health. American Diabetes Association. Diabetes Care. 2014;37(suppl 1):S14-S80.

Lifestyle ModificationFacilitating Weight Loss

● Reduce caloric intake by 500-1000 kcal/day (depending on starting weight)

● Reduce dietary fat

● Limit intake of sugar-sweetened beverages

● Dietary fiber intake of 14 grams/1000 kcal ● Whole grains are 50% of grain intake● 5-7 servings of fruits and vegetables a day

Achieving Healthy Eating HabitsPlate Method

Non-starchy vegetables●Spinach●Carrots●Lettuce●Greens●Cabbage●Green beans●Broccoli●Cauliflower●Tomatoes

Grains and starchy foods●Whole grain breads●whole wheat or rye●Whole grain●High-fiber

Protein●Chicken or turkey without the skin ●Fish such as tuna, salmon, cod or catfish●Tofu, eggs, low-fat cheese●Lean cuts of beef and pork

Adapted from:American Diabetes Association. Create your plate. Available at:

diabetes.org/createyourplate/

American Diabetes Association. Diabetes Care. 2014:37, S14-80.

Lifestyle Modification Physical Activity

Adults with prediabetes

Exercise program should include:●≥150 minutes/week of moderate-intensity aerobic activity (50%-70% maximum heart rate)

o Spread over 3 or more days every weeko No more than 2 consecutive days without exercise

●Resistance training ≥2 times/week (in absence of contraindications)*

Evaluate patients for contraindications prohibiting certain types of exercise before recommending exercise program

Consider age and previous level of physical activity†

Children with prediabetes, diabetes

Exercise program should include:≥60 minutes of physical activity/day

* For adults with type 2 diabetes† e.g., uncontrolled hypertension, severe autonomic or peripheral neuropathy, history of foot

lesions, unstable proliferative retinopathy, peripheral artery disease

Benefits of Physical Activity

● Increased insulin sensitivity

● Improved lipid levels

●Lower blood pressure

●Weight control

● Improved blood glucose control

●Reduced risk of CVD

●Prevent/delay type 2 diabetes

● Increased insulin sensitivity

● Improved lipid levels

●Lower blood pressure

●Weight control

● Improved blood glucose control

●Reduced risk of CVD

●Prevent/delay type 2 diabetes

American Diabetes Association. Diabetes Care. 2014:37:S14-80.

Association Between Insulin Sensitivity and Physical Exercise: The IRAS Study

Adapted from:Mayer-Davis EJ, et al. JAMA. 1998;279:669-674.

IRAS=Insulin Resistance Atherosclerosis Study

Lifestyle InterventionsLook AHEAD: Results

Adapted from:Gregg EW, et al. JAMA. 2012;308:2489-2496.

Any Remission of Diabetes (Partial or Complete)

p < .001 p < .001

p < .001

p < .001

● Lifestyle intervention continues to have an effect, even after 20 years

Overview of Trials in PrediabetesLifestyle Modification Intervention

Study N Intervention Treatment Risk Reduction

Da Qing1,2 IGT 577 Lifestyle6 years

20 years34% - 69%

Finnish DPS3,4 IGT 523 Lifestyle3+ years

7 years58%

Diabetes Prevention Program (DPP)5,6

IGT 3324 Lifestyle3 years

10 years

58%

34%

1. Diabetes Care. 1997;20:537-544. 2. Lancet. 2008;371:1783-1789.3. N Engl J Med. 2001;344:1343-1350. 4. Lancet. 2006;368:1673-1679.5. N Engl J Med. 2002;346:393-403. 6. Lancet. 2009;374:1677-1686.

● Pharmacologic intervention provides benefit but with increased adverse effects with some drugs

Overview of Trials in PrediabetesPharmacologic Intervention

Study N Intervention Treatment Risk Reduction

Diabetes Prevention Program (DPP)1,2

IGT 3324 Metformin3 years

10 years

31%

18%

DREAM3 IGT 5269 Rosiglitazone 3 years 60%

STOP-NIDDM4,5 IGT 1429 Acarbose 3 years 21%

ACT NOW6 IFG ~600 Pioglitazone 3 years 81%

1. Diabetes Care. 2003;6:977–980. 2. Lancet. 2009;374:1677-1686.3. Diabetes Care. 2011;34:1265-1269. 4. Lancet. 2002;359:2072-2077.5. JAMA. 2003;290:486-494. 6. N Engl J Med. 2011;364:1104-1115.

REIMBURSEMENT

S Screen

A Assess and Advise

F Follow-up

E Evaluate progress

DSME Reimbursement for Cognitive Services

● Part of the Medicare program from CMSo Program meets national

standards for DSME o Recognized by the ADA or

other approval bodies● Covered by most health

insurance plans

Diabetes Self-management Toolkit. Available at: http://www.cmspulse.org/resource-center/health-topics/diabetes/documents/DSME-Toolkit.pdf

Toolkit available from CMS to assist in the reimbursement process

ICD-9 Codes for Prediabetes Testing

ICD-9 Code* Procedure/Documentation

790.21● Impaired fasting glucose/

o Has yet to be diagnosed with diabetes

790.22● Failed glucose tolerance test/

o Has not been diagnosed with diabetes

790.29

● Evidence of other impairment of glucose metabolism/o Has not been diagnosed with diabeteso Make sure abnormal glucose levels has

been documented when using this code

277.7

● 3 of the 5 components of cardiometabolic syndrome (e.g., obese, hypertension, elevated triglycerides)/o Must report which manifestation of the

cardiometabolic syndrome the patient has

ICD-10 Codes. Available at: http://www.icd10data.com/ICD10CM/Codes/R00-R99/R70-R79/R73-/R73.09

* Will be replaced by ICD-10 codes on October 1, 2015

REFERRALS

S Screen

A Assess and Advise

F Follow-up

E Evaluate progress

Members of the Healthcare Team

Healthcare professionals take a team approach to assist patients with diabetes●Physician●Nurse practitioner/Physician assistant●Certified diabetes educator●Registered dietitian●Pharmacist●Exercise physiologist●Social worker/psychologist


Benefits of DSME and DSMS

● 4-times higher risk of diabetes complications for those who never received DSME

● Shown to positively impact:o Diabetes knowledgeo Self-care behaviorso Glycemic controlo Reduction in emergency department visits

and hospitalizations

Norris SL, et al. Diabetes Care. 2001;24:561-587.Norris SL, et al. Diabetes Care. 2002;25:1159-1171.

Benefits of DSME and DSMS

For those with or at risk for diabetes, DSME and DSMS:●Encourage behavior change●Maintenance of healthy diabetes-related behaviors●Address psychosocial concerns●Are on-going processes


● Adults BMI ≥24 kg/m2, ≥2 diabetes risk factors, blood glucose 110-199 mg/dL

● Randomized to group-based DPP lifestyle intervention or brief counseling (control)

DEPLOY Pilot Study: Diabetes Prevention in the Community

Ackermann RT, et al. Am J Prevent Med. 2008;35:357-363.

Outcome,4-6 months

Control (n=38)

Intervention (n=39)

P value(vs control)

% changein weight

−2.0(−3.3, −0.6)

−6.0(−7.3, −4.7)

< 0.001

% change BMI

−2.3(−3.7, −0.8)

−5.8(−7.3, −4.4)

0.001

Change total cholesterol

+6 mg/dL(−2.8, 14.8)

−21.6 mg/dL−29.9, −13.3)

<0.001

Practice-Based Opportunities for Weight Reduction (POWER)

Appel LJ, et al. N Engl J Med. 2011;365:1959-68.

2-Year Outcome ControlRemote

Support OnlyIn-Person Support

Mean change in weight from baseline

−0.8 kg −4.6 kg* −5.1 kg*

% patients losing ≥5% of initial weight

18.8% 38.2% 41.4%

*P<0.001 vs control arm

● Obese patients achieve, sustain significant weight loss with behavioral interventions

Diabetes TeleHealth Improves Self-Management

Davis RM, et al. Diabetes Care. 2010;33:1712–1717.

Reduction in Glycated Hemoglobin

Baseline 6 Months 12 Months

Diabetes TeleCare group

9.4±0.3 8.3±0.3* 8.2±0.4†

Usual care group 8.8±0.3 8.6±0.3 8.6±0.3

● 1-year remote DSME intervention using a dietitian, nurse/certified diabetes educator

● Improved metabolic control, reduced CV risk

*P=0.003 vs. baseline; †P=0.004 vs. baseline

S Screen

A Assess and Advise

F Follow-up

E Evaluate progress

Follow-up Counseling

● Shown to be important to success● Provide annual screenings for the

development of diabeteso Every 12 months for those with prediabeteso Every 3 years if screening is negative

● On a regular basis, search EHR to determine who needs to be screened/rescreened

● Continually screen for modifiable risk factors at each interaction


Follow-up Counseling (Con’t)

● Emphasize long-term goals of treatmento Monitor weight loss progresso Provide ongoing counseling for lifestyle

modificationo Consider pharmacologic therapy (e.g.,

metformin) if appropriate‒ IGT, IFG and/or A1C of 5.7-6.49%‒ Especially if BMI >35 kg/m2

‒ Age <60‒ Women with prior gestational diabetes

● Provide referrals to other members of the healthcare team


S Screen

A Assess and Advise

F Follow-up

E Evaluate progress

Evaluating ProgressPractitioner/Patient Communication● An integral part of clinical practice● “Manner” is as important as “what” is

communicated● Patients who understand are more likely to

o Acknowledge health problemso Understand their treatment optionso Modify behaviorso Adhere to medication schedules

● Non-verbal communication is important

Travaline JM, et al. J Am Osteopath Assoc. 2005;105:13-18.Delamater AM. Clinical Diabetes. 2006;24:71-77.

Evaluating ProgressWhat to Do

● Assess patient's concerns

● Reconcile their medications and lifestyle

● Revise the management plan as needed o If it doesn’t work in the patient’s life, it

doesn’t work

● Ask the patient to identify one strategy/goal they would like to accomplish

● Provide information about materials available to achieve goals, such as weight loss or physical activity log

Adapted from:Funnell M. Role of Diabetes Education in Patient Management.

Therapy for Diabetes Mellitus and Related Disorders.

Follow-up Assessment MaterialsDocumentation Logs

● Use a log to track different parameters:o Weighto Calorie intakeo Hours of sleep o Exercise timeo Daily fitness and

strength training

Printable Weight Loss Chart. Available at: http://www.vertex42.com/ExcelTemplates/weight-loss-chart.html

Links to Educational Materials for Patients and Healthcare

Practitioners

Prediabetes Materials for Patients

● Patient Handouts

o diabetes.org/toolkit

● Diabetes Risk Test

o diabetes.org/risktest

● National Diabetes Prevention Program

o www.cdc.gov/diabetes/prevention/

● My Health Advisor

o diabetes.org/mha

● CheckUp America

o checkupamerica.org

● Internet-based and cell phone apps for weight loss

o Various websites

Prediabetes Materials for Professionals

● ADA Clinical Practice Recommendationso Professional.diabetes.org/cpr

● On-line self-assessment programso Cardiometabolic Risko Diagnosing Prediabetes and Lifestyle

Modificationo professional.diabetes.org/ce

● ADA Diabetes is Primary webcastso Professional.diabetes.org/primary

PrediabetesConclusions

As a member of the healthcare team, YOU can make a difference ●Only 11% of people with prediabetes are aware they have it●Identify those at risk for developing diabetes: be SAFE

o Proactively Screen/rescreeno Assess/advise with management strategieso Continually Follow-up and Evaluate

●Provide educational tools for success●Collaborate with other members of the healthcare team

Thank You

Documents

PREDIABETES Strategies for Effective Screening, Intervention and Follow-up